Diagnostic value of push-type enteroscopy: a report from India

Abstract

Push-type enteroscopy is a useful test in the evaluation of patients with obscure GI bleeding and chronic diarrhea. In developing countries, in patients with obscure GI bleeding, the presence of worms in the jejunum is an important finding on enteroscopy. Tropical sprue, giardiasis, and strongyloidiasis are distinct findings in patients with chronic diarrhea in the present series.

Small bowel bleeding: a comprehensive review

“…Additionally, in tropical countries, intestinal infestation by worms can be an important cause. One study from India, in which 21 cases of obscure GI bleeding were evaluated by push enteroscopy, found worms as the cause in 28.5% of patients [80]; therefore a proper stool examination should be done in patients from tropical countries before undertaking further invasive and expensive investigations.…”

Guidelines on small bowel enteroscopy and capsule endoscopy in adults

“…A number of reported complications, which include mucosal stripping,20 duodenal perforation,17 pharyngeal tear,14 pancreatitis and Mallory–Weis tear21 have been reported with the use of the overtube and this may limit its application during enteroscopy. Later studies with graded stiffness enteroscopes have questioned the additional value of the overtube, hence many units no longer use it in routine practice 22 – 24. The depth of insertion during push enteroscopy and the length of small bowel examined (30–160 cm) is variable 13 – 15 17 21 22 24 – 31.…”

“…Later studies with graded stiffness enteroscopes have questioned the additional value of the overtube, hence many units no longer use it in routine practice 22 – 24. The depth of insertion during push enteroscopy and the length of small bowel examined (30–160 cm) is variable 13 – 15 17 21 22 24 – 31. Two methods can be used to measure the maximum length of small bowel examined: metric measurement from pylorus on withdrawal after straightening, or fluoroscopy which helps to ascertain absence of a gastric loop 18 21 22 27 31…”

“…Twelve to sixty-four per cent of lesions located with push enteroscopy are within the reach of a standard endoscope 12 – 14 21 23 24 27 37 – 40 42 43 45 46 48 50 51. Lesions commonly missed are Cameron’s ulcers (linear ulceration in large hiatus hernia), varices, peptic ulcer disease43 and gastric antral vascular ectasia (GAVE) which can be diagnosed as gastritis by the inexperienced endoscopist 52 53…”

Tropical malabsorption

“…108 Endoscopic innovations such as push enteroscopy aid in visualisation of the jejunum, directed biopsy and differentiation of tropical sprue from other diseases. 109 Characteristic histological changes include shortening of the villi, crypt hypertrophy and infiltration of the lamina propria and epithelium by mononuclear cells (fig 1). Total villous atrophy, as reported in coeliac sprue, is rare in tropical sprue.…”